Abstract
Background Group A streptococcal (GAS) infections can trigger an immune-mediated response resulting in acute rheumatic fever (ARF). The role of social and environmental risk factors for GAS pharyngitis and skin infections are not well understood. This study aimed to identify factors associated with GAS pharyngitis and skin infections, and to determine if these are the same as those for ARF. Methods A case-control study, including 733 children aged 5-14 years, was undertaken between March 2018 and October 2019 in Auckland, New Zealand. Healthy controls (n =190) and symptomatic cases including GAS pharyngitis (n = 210), GAS seronegative carriers (n = 182), and GAS skin infections (n = 151) were recruited. Trained interviewers administered a comprehensive, pre-tested, face-to-face questionnaire. Findings Multivariable analysis identified strong associations between barriers to accessing primary healthcare and having GAS pharyngitis (adjusted OR 3 center dot 3; 95% CI 1 center dot 8-6 center dot 0), GAS carriage (aOR 2 center dot 9; 95% CI 1 center dot 5-6 center dot 0) or a GAS skin infection (aOR 3 center dot 5; 95% CI 1 center dot 6-7 center dot 6). Children who had GAS skin infections were more likely than all other groups to report living in a crowded home (aOR 1 center dot 9; 95% CI 1 center dot 0-3 center dot 4), have Maori or Pacific grandparents (aOR 3 center dot 0; 95% CI 1 center dot 2-7 center dot 6), a family history of ARF (aOR 2 center dot 2; 95% CI 1 center dot 1-4 center dot 3), or having a previous diagnosis of eczema (aOR 3 center dot 9; 95% CI 2 center dot 2-6 center dot 9). Interpretation Reducing barriers to accessing primary healthcare (including financial restrictions, the inability to book an appointment, lack of transport, and lack of childcare for other children) to treat GAS pharyngitis and skin infections could potentially reduce these infections and lead to a reduction in their sequelae, including ARF. These strategies should be co-designed and culturally appropriate for the communities being served and carefully evaluated. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)